Patulous eustachian tube stent

ABSTRACT

A system effectively narrows a patulous Eustachian tube (ET) of a patient with a guide catheter, instrument, and insert. The guide catheter includes a shaft, a lumen and a distal end configured to provide access the ET when the guide catheter is inserted into a head of the patient. The instrument comprises a shaft. The insert comprises a body configured to radially expand and retract between a non-expanded state and an expanded state. The insert is sized and shaped to be received within the first lumen when in the non-expanded state and is operable to expand to the expanded state to substantially reduce an effective diameter of the ET.

BACKGROUND

Referring to FIGS. 1-2, the ear (10) is divided into three parts: anexternal ear (12), a middle ear (14) and an inner ear (16). The externalear (12) consists of an auricle (18) and ear canal (20) that gathersound and direct it toward a tympanic membrane (22) (also referred to asthe eardrum) located at an inner end (24) of the ear canal (20). Themiddle ear (14) lies between the external and inner ears (12, 16) and isconnected to the back of the throat by a Eustachian tube (ET) (26),which serves as a pressure equalizing valve between the ear (10) and thesinuses. The ET (26) terminates in a pharyngeal ostium (28) in thenasopharynx region (30) of the throat (32). In addition to the eardrum(22), the middle ear (14) also consists of three small ear bones(ossicles): the malleus (34) (hammer), incus (36) (anvil) and stapes(38) (stirrup). These bones (34, 36, 38) transmit sound vibrations tothe inner ear (16) and thereby act as a transformer, converting soundvibrations in the canal (20) of the external ear (12) into fluid wavesin the inner ear (16). These fluid waves stimulate several nerve endings(40) that, in turn, transmit sound energy to the brain where it isinterpreted.

The ET (26) is a narrow, one-and-a-half inch long channel connecting themiddle ear (14) with the nasopharynx (30), the upper throat area justabove the palate, in back of the nose. The ET (26) functions as apressure equalizing valve for the middle ear (14), which is normallyfilled with air. When functioning properly, the ET (26) opens for afraction of a second periodically (about once every three minutes) inresponse to swallowing or yawning. In so doing, it allows air into themiddle ear (14) to replace air that has been absorbed by the middle earlining (mucous membrane) or to equalize pressure changes occurring onaltitude changes. Anything that interferes with this periodic openingand closing of the ET (26) may result in hearing impairment or other earsymptoms.

Obstruction or blockage of the ET (26) results in a negative middle ear(14) pressure, with retraction (sucking in) of the eardrum (22). Inadults, this is usually accompanied by some ear discomfort, a fullnessor pressure feeling and may result in a mild hearing impairment and headnoise (tinnitus). There may be no symptoms in children. If theobstruction is prolonged, fluid may be drawn from the mucous membrane ofthe middle ear (14), creating a condition referred to as serous otitismedia (fluid in the middle ear). This may occur frequently in childrenin connection with an upper respiratory infection and account forhearing impairment associated with this condition.

When the ET (26) is blocked, the body may absorb the air from the middleear (14), causing a vacuum to form that tends to pull the liningmembrane and ear drum (22) inwardly, causing pain. Next, the body mayreplace the vacuum with more fluid which tends to relieve the pain, butthe patient can experience a fullness sensation in the ear (10).Finally, the fluid can become infected, which can lead to pain, illness,and temporary hearing loss. If the inner ear (14) is affected, thepatient may feel a spinning or turning sensation (vertigo).

Methods for treating the middle ear (14) and restriction or blockage ofthe ET (26) include those disclosed in U.S. Patent Pub. No.2010/0274188, entitled “Method and System for Treating Target Tissuewithin the ET,” published on Oct. 28, 2010, the disclosure of which isincorporated by reference herein; U.S. Patent Pub. No. 2013/0274715,entitled “Method and System for Eustachian Tube Dilation,” published onOct. 17, 2013, the disclosure of which is incorporated by referenceherein; and U.S. Pub. No. 2015/0374963, entitled “Vent Cap for aEustachian Tube Dilation System,” published Dec. 31, 2015, thedisclosure of which is incorporated by reference herein.

In some cases, rather than being restricted or blocked, the ET (26) mayfail to close properly, or such that the ET (26) takes an inordinatelyprolonged amount of time to close after being opened, such that the ET(26) substantially remains in a patulous state. This may adverselyaffect a patient by causing variations in the upper airway pressurearound the ET (26) and the middle ear (14). In some patients, a patulousET (26) may create a feeling of dry sinus, an increased breathing ratewith physical activity, higher than usual perceived volumes of sound,and/or other undesirable consequences. It may therefore be desirable toprovide a form of treatment for a patulous ET (26). It may further bedesirable for such a treatment to still provide some degree ofventilation and drainage for the ET (26), without completely closing theET (26).

While a variety of surgical instruments have been made and used, it isbelieved that no one prior to the inventors has made or used theinvention described in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim this technology, it is believed this technologywill be better understood from the following description of certainexamples taken in conjunction with the accompanying drawings, in whichlike reference numerals identify the same elements and in which:

FIG. 1 depicts a cross-sectional view of a human ear showing the inner,middle and outer ear portions and the Eustachian tube connecting themiddle ear with the nasopharynx region of the throat;

FIG. 2 depicts a cross-sectional view of a human head showing thenasopharynx region of the throat illustrated in FIG. 1 containing thepharyngeal ostium of the Eustachian tube illustrated in FIG. 1;

FIG. 3A depicts a side elevational view of an exemplary guide catheterthat may be used to position the dilation catheter of FIG. 5A;

FIG. 3B depicts a cross-sectional view of the guide catheter shown inFIG. 3A, taken along line 3B-3B of FIG. 3A;

FIG. 4 depicts an enlarged view of the distal end of the guide cathetershown in FIG. 3A;

FIG. 5A depicts a side elevational view of a balloon dilation catheterthat may be used with the guide catheter of FIG. 3A;

FIG. 5B depicts a cross-sectional view of the balloon dilation cathetershown in FIG. 5A, taken along line 5B-5B of FIG. 6;

FIG. 6 depicts an enlarged view of the distal end of the balloondilation catheter shown in FIG. 5A;

FIG. 7 depicts a perspective view of an exemplary stent in a contractedstate;

FIG. 8 depicts a perspective view of the stent of FIG. 7 in an expandedstate;

FIG. 9A depicts a cross-sectional view of the guide catheter of FIG. 3Aand the balloon dilation catheter of FIG. 5A positioned in relation tothe Eustachian tube of a patient, with the distal end of the balloondilation catheter having the stent of FIG. 7 attached thereon, the stentbeing in the contracted state;

FIG. 9B depicts a cross-sectional view of the guide catheter of FIG. 3Aand the balloon dilation catheter of FIG. 5A positioned in relation tothe Eustachian tube of FIG. 9A, with the distal end of the balloondilation catheter having the stent of FIG. 7 attached thereon, the stentbeing in the expanded state;

FIG. 10A depicts a cross-sectional side view of the balloon dilationcatheter of FIG. 5A in the Eustachian tube of FIG. 9A, with the dilatorin a deflated state to slidably position the stent of FIG. 7 within theEustachian tube;

FIG. 10B depicts a cross-sectional side view of the balloon dilationcatheter of FIG. 5A being withdrawn from the Eustachian tube of FIG. 9A,with the dilator being in a deflated state after having been expanded toan inflated state to secure the stent of FIG. 7 to the inner wall of theEustachian tube;

FIG. 10C depicts a cross-sectional side view of the Eustachian tube ofFIG. 9A, with the balloon dilation catheter of FIG. 5A removed, and withthe stent of FIG. 7 returned back to a contracted state thereby pullingthe inner wall of the Eustachian tube inwardly;

FIG. 11 depicts a perspective view of the stent of FIG. 7 in an expandedstate fastened against the inner walls of the Eustachian tube;

FIG. 12 depicts a perspective view of an exemplary Eustachian tube plugin an expanded state;

FIG. 13 depicts a perspective view of the Eustachian tube plug of FIG.12 in a contracted state;

FIG. 14 depicts a perspective view of an exemplary alternativeEustachian tube plug including a plurality of pores along the proximaland distal ends, with the Eustachian tube plug in an expanded state;

FIG. 15 depicts a perspective view of the Eustachian tube plug of FIG.14 in a contracted state;

FIG. 16A depicts a cross-sectional side view of a Eustachian tube with asheath slidably advanced therein, the sheath containing the Eustachiantube plug of FIG. 12 or FIG. 14 therein, with the Eustachian tube plugrestricted to the contracted state by the dilation catheter;

FIG. 16B depicts a cross-sectional side view of the Eustachian tube ofFIG. 16A, with the Eustachian tube plug advanced distally from thesheath and with the Eustachian tube plug still in the contracted state;

FIG. 16C depicts a cross-sectional side view of the Eustachian tube ofFIG. 16A, with the Eustachian tube plug released from within the sheathand in an expanded state, the sheath being slidably retracted;

FIG. 17A depicts a cross-sectional view of a Eustachian tube with asheath slidably advanced therein, the sheath containing the Eustachiantube plug of FIG. 12 or FIG. 14 therein, with the Eustachian tube plugrestricted to the contracted state by the dilation catheter;

FIG. 17B depicts a cross-sectional view of the Eustachian tube of FIG.17A, with the sheath slidably retracted and the Eustachian tube plugexposed from within the sheath; and

FIG. 17C depicts a cross-sectional view of the Eustachian tube of FIG.17A, with the Eustachian tube plug released from within the sheath andin an expanded state, the sheath being slidably retracted.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following detailed description should be read with reference to thedrawings, in which like elements in different drawings are identicallynumbered. The drawings, which are not necessarily to scale, depictexemplary examples for the purpose of explanation only and are notintended to limit the scope of the invention. The detailed descriptionillustrates by way of example, not by way of limitation, the principlesof the invention. This description will clearly enable one skilled inthe art to make and use the invention, and describes several examples,adaptations, variations, alternative and uses of the invention,including what is presently believed to be the best mode of carrying outthe invention.

As used herein, the terms “about” and “approximately” for any numericalvalues or ranges indicate a suitable dimensional tolerance that allowsthe part or collection of components to function for its intendedpurpose as described herein.

I. Exemplary Eustachian Tube Catheter System

One example of a treatment that may be performed to treat an ET (26)that is in a patulous state for a prolonged period includes accessingand contacting the walls of the ET (26) with an implant that is deployedusing a guide catheter (100) and a balloon dilation catheter (200),examples of which are shown in FIGS. 3A-6. Guide catheter (100) of thepresent example includes an elongate tubular shaft (102) that has aproximal end (104), a distal end (106) and a lumen (108) therebetween.The guide catheter (100) may have any suitable length, diameter, angleof bend, and location of the bend along the length of the catheter(100), to facilitate accessing an ET (26) opening, such as thepharyngeal ostium (28). In some examples, the guide catheter (100) mayhave a length between about 8 cm and about 20 cm, or more particularlybetween about 10 cm and about 15 cm, or more particularly about 11 cm.

FIG. 3B is a cross-sectional view of the elongate tubular shaft (102) ofguide catheter (100). As can be seen, shaft (102) has an outer shafttube (110), an inner shaft tube (112) and a lumen (108). The outer shafttube (110) may be constructed of a stiff material such as stainlesssteel and the inner shaft tube (112) may be constructed of a moreflexible material such as a polymeric material including but not limitedto nylon and further including a PTFE liner. The lumen (108) has adiameter of between about 2 mm and 3 mm, preferably between about 2.5 mmand about 2.6 mm, such that the balloon dilation catheter (200) can beeasily inserted into the lumen (108) for treating the ET (26). Thecombination of guide catheter (100) and balloon catheter (200) may acompact system that is designed for a one-handed procedure. By“compact,” it is intended that the length of the guide catheter shaftthat is distal of the bend in the guide catheter is between about 0.5and 2.0 about cm, in some versions between about 1 and about 2 cm, andin some versions about 1 cm. The compactness may help reduceinterference with other instruments, such as an endoscope (60) that maybe used to help in visualizing the positioning of the system, asdescribed below.

The distal portion (120) of guide catheter (100) is shown in an enlargedview in FIG. 4. The distal portion (120) of the guide catheter (100) mayhave a bend (122) with an angle between about 45 degrees and about 65degrees, and more preferably between about 50 degrees and about 60degrees, and particularly about 55 degrees, to facilitate access intothe ET (26) via the pharyngeal ostium (28). The distal portion (120) ofthe guide catheter (100) is made of a transparent material such as apolymer including but not limited to nylon and PTFE such that balloondilation catheter (200) is visible within the distal portion (120) andsuch that distal portion (120) is more flexible than the elongate shaft(102). The distal tip (124) of the distal portion (120) of the guidecatheter (100) is made of PEBAX® (polyether block amide) such that itprovides for atraumatic access to the ET (26), and may contain 20%barium sulfate or other similar radiopaque materials for visualizableaccess.

Referring again to FIG. 3A, the proximal portion (130) of guide catheter(100) includes a proximal hub (132) to aid in insertion of the ballooncatheter into the ET (26). The hub (132) has a larger diameter proximalend (134) and a smaller diameter middle section (136) to facilitatestabilization of the guide catheter (100) in the nose, rotation of theguide catheter (100), and insertion of the balloon catheter (200) aswill be described in further detail below. The hub (132) isergonomically designed for insertion, location, and rotation throughslight manipulations with one hand.

Balloon dilation catheter (200) of the present example is shown in FIG.5A. The balloon dilation catheter (200) of the present example generallyincludes an elongate shaft (202) having a proximal end (214) and adistal end (218). The balloon dilation catheter (200) further includes aballoon (204) on the distal end (218) of the elongate shaft (202). Theballoon (204) may be a polymer balloon (compliant, semi-compliant, ornon-compliant). In some versions, the balloon (204) comprises a suitablenon-compliant material such as but not limited to polyethyleneterepthalate (PET), PEBAX® (polyether block amide), nylon or the like.The balloon catheter (200) may include any size of balloon including,but not limited to, balloons of 2 mm to 8 mm in diameter or of betweenabout 5 mm and 6 mm (when inflated) and 12 mm to 24 mm in working length(for example 2 mm×12 mm, 3.5 mm×12 mm, 5 mm×16 mm, 5 mm×24 mm, 6 mm×16mm, 6 mm×20 mm, 6 mm×24 mm, 7 mm×16 mm and 7 mm×24 mm) The balloondilation catheter (200) generally includes a proximally locatedconnection (230) for inflating/activating the balloon (204) bycommunicating a pressurized medium (e.g., saline) to balloon (204).

Balloon (204) may be expanded to interact with an expandable stent (300)to treat the ET (26) after balloon (204) is placed in a desirablelocation in the ET (26), as shown in FIGS. 10A-10B and described ingreater detail below. For example, the opening area of the ET (26)includes a pharyngeal ostium (28), and dilation catheter (200) may beadvanced to position balloon (204) in the pharyngeal ostium (28). Anendoscope (60) may be used to assist in positioning the dilationcatheter (200). The endoscope (60) may be advanced through the nasalpassage to view the dilation catheter (200). A marker (208) on a shaftof the dilation catheter (200) can be viewed from the endoscope (60) toapproximate a location of the balloon (204) relative to the opening ofthe ET (26) (e.g., pharyngeal ostium (28)) based on a distance of themarker (208) from a proximal end of the balloon (204). Accordingly,dilation catheter (200) can be moved to place marker (208) in adesirable location before expansion of the balloon (204) in the ET (26).

Balloon dilation catheter (200) further includes an actuator (210).Actuator (210) has a proximal side 220 and a distal side (222). In theexample shown in FIG. 5A, actuator (210) is secured by an adhesive toelongate shaft (202). The portion (240) of elongate shaft (202) that isdistal of actuator (210) is sufficiently stiff to be guided through thenasal cavity and into the ET (26) and is constructed of stainless steeland may include a stainless steel hypotube. The portion (238) ofelongate shaft (202) that is proximal of actuator (210) and the portion(250) that is distal to portion (240) is more flexible than the portion(240) and is constructed of a polymeric material including but notlimited to PEBAX® (polyether block amide). In this way, proximal portion(238) of elongate shaft (202) will not interfere with the endoscope (60)described above as it is advanced through the nasal passage, such thatthe dilation catheter (200) can be easily viewed. The actuator (210)allows for easy, ergonomic one-handed advancement of dilation catheter(200) through guide catheter (100) and into the ET (26). Actuator (210)may be used to advance or retract in alternative ways including but notlimited to use of the thumb, the index finger, or a combination offingers (e.g., the index and middle fingers) or the thumb and the indexor middle finger.

The distal end (218) of balloon catheter (200) further includes a tip(212) and a flexible shaft portion (250) that is constructed of apolymeric material including but not limited to PEBAX® (polyether blockamide) that extends from the distal end of the elongate shaft (202) tothe proximal end of balloon (204). In the example shown in FIG. 5A, tip(212) is a bulbous polymeric blueberry shaped, atraumatic tip and isabout 1.5 mm to about 2 mm in length, with an outer diameter of betweenabout 2 mm and about 3 mm. The smoothness and roundness of tip (212)facilitates advancement of the balloon catheter (200) by helping itglide smoothly through the ET (26). Tip (212) further acts as a safetystop. The isthmus (29) of the ET (26), shown in FIG. 1 is approximately1 mm in diameter. The tip (212) diameter is larger than the outerdiameter (233) of the elongate shaft (202) shown in cross-section inFIG. 5B such that the tip (212) size will prevent the balloon catheter(200) from passing through the isthmus (29) into the middle ear (14).

After balloon (204) is positioned within the ET (26) and inflated to anexpanded state (e.g., as shown in FIG. 10B), balloon (204) may be heldin location while in an expanded state for an extended period of time(e.g. several seconds or minutes). The balloon catheter (200) may alsodeliver a substance to the ET (26), such as one or more therapeutic ordiagnostic agents. As described further below, balloon (204) may alsocarry an expandable stent (300) for delivery into the ET (26) uponexpansion of balloon (204). Balloon dilation catheter (200) and guidecatheter (100) may be removed from the patient after balloon (204) hasbeen deflated/unexpanded, leaving stent (300) deployed in the ET (26).The ET (26) will resume functioning, normally opening and closing toequalize atmospheric pressure in the middle ear (14) and protect themiddle ear (14) from unwanted pressure fluctuations and loud sounds.

II. Exemplary Method of Treating the Eustachian Tube

As noted above, some patients may have an ET (26) that remains patulousfor a prolonged period, which may be undesirable for various reasons. Itmay therefore be desirable to insert a stent or other device into apatient's patulous ET (26), where the inserted stent or other device iscapable of reducing the effective size of the ET (26) to therebyalleviate the negative effects created by the disorder. Providing astent that has a narrow configuration but is able to expand outwardly toengage the inner walls of the ET (26) may be beneficial to avoidforcibly advancing an expanded rod into a patient's ET (26). In thisinstance, a stent is minimally invasive when initially inserted into theET (26) but is subsequently expanded to fasten against the inner wallsof the ET (26) to thereby pull the inner walls inwardly towards eachother, forming a smaller diameter for the ET (26). By reducing theeffective inner diameter of the ET (26), the patient may be alleviatedof the various issues that are created when the ET (26) is in anabnormally enlarged state for a prolonged duration.

The following description provides various examples of devices that areconfigured to be deployed within the ET (26) to reduce the effectivediameter of the ET (26). Ultimately, reducing the effective innerdiameter of the ET (26) into a smaller profile for a prolonged periodmay be beneficial to minimize the likelihood that a patient willcontinue to experience the issues commonly associated with an ET (26)that maintains an abnormally large profile over a prolonged duration.

It should be understood that the stents and/or Eustachian tube plugsdescribed below may be readily incorporated into any of the variousguide members and dilation catheters described above and in any of thevarious surgical procedures described in the various referencesdescribed herein. Other suitable ways in which the below-describedstents and/or Eustachian tube plugs may be used will be apparent tothose of ordinary skill in the art in view of the teachings herein.

A. Patulous Eustachian Tube Stent with Tissue Binding Coating

FIGS. 7-8 show an exemplary stent (300) including an interior surface(302) and an exterior surface (304) extending between a proximal opening(306) and a distal opening (308). As will be described in greater detailbelow, openings (306, 308) are configured to provide access to interiorsurface (302) of stent (300) for an object, for example dilationcatheter (200), to be received therein. Stent (300) is an elongate,cylindraceous device that is configured to be expandable about alongitudinal axis (301). As seen in FIG. 7, stent (300) is configured tonaturally be in a contracted state by default such that stent (300) isresiliently biased to assume the contracted state upon the expansion ofstent (300). Interior surface (302) and exterior surface (304) include aplurality of longitudinal struts (310) in a woven or looped arrangementsuch that each strut (310) of the plurality of struts (310) isimmediately adjacent to another strut (310) thereby forming a meshdesign or pattern. The mesh pattern of surfaces (302, 304) is configuredto accommodate and allow for the expandability of stent (300). In otherwords, stent (300) is configured to be radially expandable from theselective separation and extension of the plurality of struts (310)along surfaces (302, 304), as seen in FIG. 8. In this instance, stent(300) is operable to be stretched to an expanded state upon theapplication of a predetermined outwardly directed force onto interiorsurface (302) and within stent (300).

Interior surface (302) and exterior surface (304) are configured to havea flexible configuration such that stent (300) is both expandable andeasily maneuverable while in a contracted state for implantation withina patient's body, for example, in an ET (26). Surfaces (302, 304) ofstent (300) may be formed of a metal bio-absorbable material. Moreover,surfaces (302, 304) may be coated with a biocompatible polymer coating.As merely an illustrative example, stent (300) may be formed ofResoloy®, a bioresorbable magnesium-alloy manufactured by MeKo LasterMaterial Processing, Hannover, Germany. Alternatively, for example,stent (300) may be formed of a biodegradable thermoplastic such aspolylactic acid. In either instance, by being formed of a biocompatiblematerial, stent (300) is configured to degrade within a patient's bodyafter a predetermined degradation time. In other examples, stent (300)may be formed of a non-degradable material such that stent (300) isrequired to be manually removed; or such that stent (300) simply remainsin the patient's body.

Stent (300) is further formed of a material that includes shape memoryand/or elastic characteristics suitable for insertion into a patient'sbody. With the shape memory characteristics, stent (300) is resilientlybiased to deform inwardly back to the default, contracted state (FIG. 7)after the selective expansion of surfaces (302, 304) to the expandedstate (FIG. 8). In this instance, stent (300) has a resilient strengththat is naturally inclined to transform back to an original contractedstate up to a predetermined strength, such that stent (300) returns tothe contracted state despite the presence of an intervening restraint orcounter force applied thereon. As merely an illustrative example, stent(300) may be formed of an alloy such as Nitinol that includes shapememory and/or superelastic characteristics.

Stent (300) is further shaped and sized such to allow stent (300) toslidably advance into ET (26) when in the contracted state. For example,stent (300) may be sized between approximately 0.071 inches andapproximately 0.124 inches (length) by approximately 0.0063 inches andapproximately 0.0085 inches (width). Other various suitable dimensionswill be apparent to those of ordinary skill in the art in view of theteachings herein.

Stent (300) further includes a tissue binding coating (312) alongexterior surface (304). Tissue binding coating (312) is operable tofasten stent (300) against adjacent tissue upon the tissue contactingexterior surface (304). As such, stent (300) is configured to securelyengage an adjacent tissue upon selectively abutting exterior surface(304) along the adjacent tissue. By way of example only, tissue bindingcoating (312) may comprise isocyanate, cyanoacrylate, and/or any othersuitable biocompatible adhesive. Other suitable materials that may beused will be apparent to those of ordinary skill in the art in view ofthe teachings herein. Although not shown, it should be understood thatother fastening means or mechanisms may be included along exteriorsurface (304) to thereby allow stent (300) to securely attach to anadjacent tissue. For example, stent (300) may include barbs or othermechanical anchoring features along exterior surface (304) that areconfigured to fasten stent (300) to ET (26).

In the present example, as seen in FIG. 9A, guide catheter (100),dilation catheter (200), and stent (300) are cooperatively used to treatthe ET (26) under visual guidance using an endoscope (60). In use, guidecatheter (100) may be advanced into a nostril and through a nasal cavityto position a distal end of catheter (100) at, in or near the pharyngealostium (28), which opens into the ET (26). In some variations, guidecatheter (100) is advanced via the patient's mouth to reach thepharyngeal ostium (28). In either case, with the distal end of guidecatheter (100) positioned at pharyngeal ostium (28), a guidewire (notshown) may be slidably advanced through dilation catheter (200), towardand into the ET (26). With the distal end of the guidewire extended intothe ET (26), dilation catheter (200) and stent (300) are slidablyadvanced together along the guidewire into the ET (26) to a desiredlocation for treatment. In particular, stent (300) is positioned onballoon (204) of dilation catheter (200) such that stent (300) advancesunitarily with dilation catheter (200) into the ET (26). In other words,balloon (204) is positioned within interior surface (302) of stent(300). An adhesive and/or other feature(s) may be used to removablysecure stent (300) to balloon (204). FIG. 10A shows dilation catheter(200) positioned such that balloon (204) and stent (300) are located inthe ET (26), with balloon (204) in a non-expanded state, and with stent(300) in a contracted state.

In some instances, guide catheter (100), dilation catheter (200) andstent (300) may be passed through a nostril to the ET (26) on theipsilateral (same side) of the head. In some other instances, guidecatheter (100), dilation catheter (200) and stent (300) may be passedthrough a nostril to the ET (26) on the contralateral (opposite side) ofthe head. A guiding element such as an illuminating fiber may be used toaid in accessing the ET (26). A physician/user may place the index andmiddle fingers on either side of the smaller diameter middle section(136) of proximal hub (132) of guide catheter (100) and then place thethumb on the proximal side (220) of actuator (210), or within both sidesof the actuator (210), and will use the thumb to slide the dilationcatheter (200) through guide catheter (100) to position balloon (204)and stent (300) within the ET (26). Alternatively, the user may graspproximal hub (132) of guide catheter (100) and use the index fingerplaced on the proximal side (220) of actuator (210) or in between thedistal side (222) and the proximal side (220) of actuator (210) toadvance dilation catheter (200) and stent (300).

The larger diameter tip (212) prevents balloon catheter (200) fromadvancing past the isthmus (29) and into the middle ear (14). Further,distal side (222) of actuator (210) will bottom out against proximal end(104) of guide catheter (100), such that the dilation catheter (200)cannot advance any further. The actuator (210) thus prevents thedilation catheter (200) from reaching past the isthmus (29) and reachingthe middle ear (14). Further, actuator (210) can be positioned at theappropriate distance along the elongate shaft (202) such that access tothe ET (26) may be from the contralateral or the ipsilateral side.

In an alternative example, dilation catheter (200) is advanced into anostril of a patient without the use of a guidewire. As yet anotheralternative example, dilation catheter (200) may be advanced into anostril of a patient without the use of a guide catheter (100). Balloon(204) of dilation catheter (200) may be placed directly within the ET(26), with stent (300) removably secured to balloon (204). Thephysician/user may advance dilation catheter (200) until the proximalside (220) of the actuator (210) is adjacent the patient's nostril. Thedistal side (222) of actuator (210) may bottom out against the patient'snostril, such that the dilation catheter (200) cannot advance anyfurther. The actuator (210) prevents the catheter from passing theisthmus (29) and reaching the middle ear (14). Further, actuator (210)can be positioned at the appropriate distance along the elongate shaft(202) such that access to the ET (26) may be from the contralateral orthe ipsilateral side.

As best seen in FIG. 9B, with balloon (204) of dilation catheter (200)located within interior surface (302), fluid is communicated to balloon(204) to thereby inflate balloon (204) and expand stent (300) from thecontracted state to the expanded state. The elongate shaft (202)contains adjacent dual lumen (232, 234) tubing (see FIG. 5B). Byadjacent dual lumen tubing, it is intended that the lumens (232, 234)are next to each other but are spaced apart, one from the other. Theinflation lumen (232) is used for inflation of the balloon (204) withwater, contrast medium, or saline through inflation port (230) to apressure of between about 3 and about 15 atmospheres, or of betweenabout 6 and about 12 atmospheres. The injection lumen (234) permits theoptional injection of water, medicament, or even the introduction of aguidewire through the injection port (236) at the proximal end (216) ofthe proximal connector (206).

In order to ensure that inflation port (230) is used for balloon (204)inflation only, inflation port (230) and injection port (236) mayoptionally have different type connectors. For example, inflation port(230) may be a female connector whereas injection port (236) is a maleconnector or vice versa. Alternatively, injection port (236) may have aright-handed thread connector and inflation port (230) may have aleft-handed thread connector or vice versa.

As best seen in FIG. 10B, with stent (300) transitioned to the expandedstate by the inflation of balloon (204), the plurality of struts (310)along surface (302, 304) are separated in a widened arrangement therebyresulting in exterior surface (304) contacting tissue sidewall (27) ofthe ET (26). As seen in FIG. 11, with exterior surface (304) abuttingagainst tissue sidewall (27), stent (300) becomes securely fastened totissue sidewall (27) due to the presence of tissue binding coating (312)along exterior surface (304) of stent (300). As such, stent (300)remains in the expanded state, securely fastened to tissue sidewall (27)of the ET (26), despite the withdrawal of balloon (204) from withinstent (300).

With exterior surface (304) securely fastened to the ET (26) via tissuebinding coating (312), stent (300) gradually retracts inwardly towardlongitudinal axis (301) due to the absence of inflated balloon (204)positioned between interior surface (302), and due to the resilient biasof stent (300) urging stent (300) to return to the contracted state. Asseen in FIG. 10C, the plurality of struts (310) along surfaces (302,304) gradually return to an original position where stent (300) istransitioned back to the contracted state. In this instance, tissuesidewall (27) is simultaneously retracted inwardly, due to thecoated-engagement with exterior surface (304), toward longitudinal axis(301) of stent (300). At this point, the abnormally enlarged diameter ofET (26) is effectively minimized to a predetermined diameter of surfaces(302, 304) in the contracted state. It should be understood thepredetermined diameter of surfaces (302, 304) in the contracted state isdetermined in accordance with clinical data for normal sizes of anEustachian Tube. Thus, the ET (26) is closed to a smaller profile for apredetermined period depending on the bio-absorption properties of stent(300).

It should be understood that, with stent (300) deployed in the ET (26),the ET (26) will be resiliently biased (by stent (300)) to assume asubstantially closed state. Nevertheless, the properties of stent (300)may still allow ET (26) to open when the patient yawns or swallows, aswould be expected in a normally operating ET (26), such that the ET (26)may still provide ventilation and drainage for the middle ear (14) evenafter stent (300) is deployed in the ET (26).

In versions where stent (300) is formed of a biodegradable orbioabsorbable material, stent (300) may be further configured to promotethe growth of scar tissue within the ET (26). By way of example only,scar tissue growth may be promoted by one or more coatings on stent(300) and/or by one or more structural features of stent (300). Inversions where stent (300) promotes the growth of scar tissue in the ET(26), the scar tissue may effectively maintain a reduced inner diameterin the ET (26), such that the scar tissue itself provides a long-termremedy to the otherwise patulous ET (26) after stent (300) has degradedor been absorbed.

B. Patulous Eustachian Tube Plug with Tissue Binding Coating

FIGS. 12-13 show an exemplary plug (400) including an elongated shaft(402) extending between a proximal end (404) and a distal end (406).Plug (400) is a longitudinal, cylindraceous device that is configured tobe compressible. As seen in FIG. 12, plug (400) is configured tonaturally be in an expanded or enlarged state by default. Plug (400) isformed of a silicone or other elastomeric material that has elasticproperties allowing plug (400) to be compressible between the expandedstate to a compressed state, as seen in FIG. 13. In other words, plug(400) is configured to be radially compressed and axially lengthenedwhen compressed from the original expanded state (FIG. 12) to thecompressed state (FIG. 13). In this instance, plug (400) is operable tobe stretched or narrowed to a smaller profile when in a compressed stateupon the application of a predetermined force onto the exterior surfaceof elongated shaft (402). By stretching plug (400) axially through theapplication of a force, plug (400) forms and maintains a smaller radialprofile for as long as the force continues to be exerted onto theexterior surface of elongated shaft (402).

Although not shown, it should be understood that plug (400) may beoppositely configured such that plug (400) is naturally inclined to bein a narrow configuration or profile, as seen in FIG. 13. In thisexample, plug (400) is configured to be radially expanded and axiallyshortened when compressed along ends (404, 406) to thereby transition tothe enlarged state shown in FIG. 12. Other various suitable arrangementsor relationships of plug (400) will be apparent to those of ordinaryskill in the art in view of the teachings herein.

In some versions, an exemplary plug (500) may include a plurality ofpassageways (508) extending along the longitudinal length of plug (500)between a proximal end (504) and distal end (506), as seen in FIGS.14-15. It should be understood that plug (500) of this example may beconfigured and operable just like plug (400) described above, except forthe differences explicitly noted herein. Passageways (508) areconfigured to form a plurality of empty pockets along the longitudinallength of plug (500) to thereby allow plug (500) to have negative spacecontained therein. As best seen in FIG. 15, with the inclusion ofpassageways (508) within plug (500), plug (500) is configured to becompressed to an even smaller profile as the negative spaces created bypassageways (508) are substantially reduced. In other words, passageways(508) provide additional ease in compressing plug (500).

In the present example, the ends of passageways (508) along proximal end(504) and distal end (506) are circular in shape. Although not shown, itshould be understood passageways (508) may comprise various suitableshapes or profile as will be apparent to those of ordinary skill in theart in view of the teachings herein. As merely an illustrative example,passageways (508) may have a honeycomb shape. Passageways (508) arefurther configured to provide ventilation and drainage paths throughplug (500) when positioned within the ET (26) to thereby enable fluidcommunication through plug (500).

In use, as similarly described above with respect to the installation ofstent (300) within the ET (26), guide catheter (100) is advanced into anostril and through a nasal cavity to position a distal end of catheter(100) at, in or near the pharyngeal ostium (28), which opens into the ET(26). With the distal end of guide catheter (100) positioned atpharyngeal ostium (28), a hollow sheath (480) is slidably advancedthrough guide catheter (100). Hollow sheath (480) comprises an internalchannel (482) extending between a proximal opening (not shown) and adistal opening (484). Hollow sheath (480) has a push rod (490) and plug(400, 500) slidably disposed in internal channel (482) and containedtherein. In particular, push rod (490) and plug (400, 500) arepositioned in internal channel (482) such that distal end (406, 506) ofplug (400, 500) is positioned adjacent to distal opening (484), withpush rod (490) positioned at proximal end (404, 504) of plug (400, 500).

With push rod (490) abutting against proximal end (404, 504) of plug(400, 500), push rod (490) ensures that plug (400, 500) does notproximally translate within internal channel (482) and away from distalopening (484). Internal channel (482) has a diameter that is smallerthan a diameter of plug (400, 500) when plug (400, 500) is in thenaturally expanded state, such that plug (400, 500) is compressed to thenarrow state within internal channel (482), as seen in FIG. 16A. Inother words, with plug (400, 500) positioned within internal channel(484), plug (400, 500) is restricted to and maintained in the compressedstate due to the radial force exerted upon elongated shaft (402, 502) bythe smaller profile of hollow sheath (480). Hollow sheath (480) isselectively advanced through the ET (26) until distal opening (484) ispositioned proximate to a desired location for releasing plug (400,500). As seen in FIG. 16B, push rod (490) is distally translated withininternal channel (482) thereby encountering proximal end (404, 504) ofplug (400, 500). Sheath (480) remains longitudinally stationary as pushrod (490) is advanced distally relative to sheath (480). In thisinstance, plug (400, 500) is pushed out of internal channel (482) andthrough distal opening (484) until proximal end (404, 504) extendsbeyond distal opening (484).

As seen in FIG. 16C, with plug (400, 500) extended distally beyondhollow sheath (480), plug (400, 500) resiliently expands to the originalenlarged state. Plug (400, 500) is able to expand due to the absence ofthe radial force previously exerted onto exterior surface (402, 502) byhollow sheath (480). In this instance, elongated shaft (402, 502)continues to expand until encountering tissue sidewall (27) of the ET(26). With plug (400, 500) securely engaged against tissue sidewall (27)within the ET (26), the ET (26) effectively adopts a smaller profile incontrast to the abnormally large diameter of ET (26) without plug (400,500) positioned therein. After plug (400, 500) is released from hollowsheath (480) at a desired position within the ET (26), hollow sheath(480) and push rod (490) are withdrawn from the ET (26) leaving plug(400, 500) in place within the ET (26). In instances where plug (500) isdeployed, passageways (508) will provide ventilation and a drainagepaths through plug (500) despite plug (500) being positioned within theET (26). Even with such ventilation and drainage paths, plug (500) willstill provide an effectively reduced diameter for the ET (26), therebyrelieving the patient of the symptoms associated with a patulous ET(26).

Alternatively, in some applications, hollow sheath (480) is selectivelyadvanced through the ET (26) until distal opening (484) is positioned atthe desired location for plug (400, 500) to engage the ET (26), as seenin FIG. 17A. In this instance, in contrast to the prior method ofpositioning distal opening (484) proximate to the desired location whereplug (400, 500) will be released from internal channel (482) asdescribed above, distal opening (484) is selectively positioned at thelocation where plug (400, 500) is to engage the ET (26). In particular,as seen in FIG. 17B, hollow sheath (480) is extracted distally withinthe ET (26) while push rod (490) is steadily maintained in position,thus not being extracted distally with hollow sheath (480) despite beingcontained within internal channel (482).

In other words, as hollow sheath (480) is retracted from ET (26), pushrod (490) is held in place in continued abutment with proximal end (404,504) of plug (400, 500) such that distal end (406, 506) of plug (400,500) beings to extend beyond distal opening (484). In this instance,plug (400, 500) is exposed from internal channel (482) as hollow sheath(480) is distally translated. FIG. 17C shows hollow sheath (480)substantially retracted from the ET (26) such that plug (400, 500) is nolonger contained within internal channel (482), with a distal end ofpush rod (490) extending through distal opening (484) and maintainingplug (400) at the desired location through the engagement with proximalend (404, 504). With plug (400, 500) not contained within internalchannel (482), plug (400, 500) resiliently expands to the originalenlarged state. Plug (400, 500) radially expands due to the absence of aradial force that was previously applied to the exterior surface ofelongated shaft (402, 502) through the confinement of internal channel(482).

As similarly described above, elongated shaft (402, 502) of plug (400,500) expands radially until encountering tissue sidewall (27) of the ET(26). With plug (400) securely engaged against tissue sidewall (27)within the ET (26), ET (26) effectively adopts a smaller profile incontrast to the abnormally large diameter of ET (26) without plug (400,500) positioned therein. After plug (400, 500) is exposed from withinhollow sheath (480) at the desired location within the ET (26), hollowsheath (480) and push rod (490) are withdrawn from the ET (26) leavingplug (400, 500) in place within ET (26).

III. Exemplary Combinations

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

A system for providing a restriction in a patulous Eustachian tube (ET)of a patient, the system comprising: (a) a guide catheter comprising ashaft and a lumen extending therebetween, wherein the guide catheterfurther comprises a distal end configured to provide access to anopening in the ET when the guide catheter is inserted into a head of thepatient; (b) an instrument comprising a shaft; and (c) an insertcomprising a body configured to radially expand and retract between anon-expanded state and an expanded state, wherein the instrument isoperable release the insert in the ET, wherein the insert is sized andshaped to be received within the lumen of the guide catheter when in thenon-expanded state, wherein the insert is configured to reduce aneffective diameter of the ET after transitioning from the expanded stateto the non-expanded state in the ET or after transitioning from thenon-expanded state to the expanded state in the ET.

Example 2

The system of Example 1, wherein the insert is resiliently biased to thenon-expanded state.

Example 3

The system of Example 2, wherein the instrument further includes anexpandable member, wherein the insert is configured to expand to theexpanded state in response to a radially outward force applied to thebody by the expandable member.

Example 4

The system of Example 3, wherein the insert is sized and configured toreceive the expandable member when the insert is in the non-expandedstate.

Example 5

The system of any one or more of Examples 3 through 4, wherein theinsert is releasably secured to the expandable member.

Example 6

The system of any one or more of Examples 1 through 5, wherein the bodycomprises a plurality of longitudinal struts, wherein the struts areassembled in a looped arrangement such that each strut is adjacent toanother strut thereby forming a mesh pattern.

Example 7

The system of any one or more of Examples 1 through 6, wherein theinsert further comprises a fastening mechanism configured to securelyattach the insert to the ET upon contact between the body and the ET.

Example 8

The system of Example 7, wherein the fastening mechanism is positionedalong the body.

Example 9

The system of any one or more of Examples 7 through 8, wherein thefastening mechanism comprises a tissue binding coating along an outersurface of the body.

Example 10

The system of any one or more of Examples 1 through 9, wherein theinsert is formed of a biodegradable material such that the insert isconfigured to dissolve after a predetermined duration within the ET.

Example 11

The system of any one or more of Examples 1 through 10, wherein theinsert is formed of an elastic material operable to flexibly expand thebody.

Example 12

The system of any one or more of Examples 1 or 6 through 11, wherein theinsert is resiliently biased toward the expanded state, wherein theguide catheter is configured to constrain the insert in the non-expandedstate.

Example 13

The system of Example 12, wherein the body is configured to contractlongitudinally when radially expanded to the expanded state.

Example 14

The system of any one or more of Examples 12 through 13, wherein theinsert includes a plurality of passageways extending within the body,wherein passageways are configured to enable fluid communication throughthe body.

Example 15

The system of any one or more of Examples 12 through 14, wherein theinstrument further comprises a pusher operable to drive the insert outof the guide catheter in response to relative longitudinal movementbetween the guide catheter and the pusher.

Example 16

An apparatus for providing a restriction in a patulous Eustachian tube(ET) of a patient, the apparatus comprising: (a) a body, wherein thebody is resiliently biased to radially expand from an elongated state toa widened state, wherein a longitudinal length of the body is configuredto shorten when in the widened state such that the longitudinal lengthof the body is longer in the elongated state relative to the widenedstate, wherein the body is sized and configured to be inserted in an ETwhen the body is in the elongated state, wherein the body is sized andconfigured to bear against a sidewall of the ET when the body is in thewidened state; (b) a plurality of passageways formed through the body;wherein the body in the elongated state is sized and configured to bereceived within an interior of a shaft; and wherein the body in thewidened state is operable to provide restricted fluid communicationthrough an ET through via the passageways.

Example 17

The apparatus of Example 16, wherein the body is formed of abiodegradable material such that the body is configured to dissolveafter a predetermined duration within the ET.

Example 18

A method for providing a restriction in a patulous Eustachian tube (ET)of a patient using an insert, wherein the insert comprises a bodyconfigured to be expandable from a contracted state to an expandedstate, the method comprising: (a) directing the insert into an oro-nasalcavity of the patient while the insert is in the contracted state; (b)advancing the insert into an opening of the ET; (c) further advancingthe insert within the ET to a desired target site; (d) expanding theinsert to the expanded state; and (e) restricting an effective diameterof the ET via the insert.

Example 19

The method of Example 18, wherein the insert is resiliently biasedtoward the contracted state, wherein the acts of directing, advancing,and further expanding are performed using an instrument having anexpandable member, wherein the insert is carried by the expandablemember, wherein the act of expanding the insert comprises expanding anexpandable member to overcome the resilient bias of the insert, whereinthe expanded insert is secured to the ET, wherein the act of restrictingthe effective diameter of the ET comprises contracting the expandablemember, thereby allowing the insert to resiliently return to thecontracted state.

Example 20

The method of Example 18, wherein the insert is resiliently biasedtoward the expanded state, wherein the acts of directing, advancing, andfurther expanding are performed using an instrument having an outersheath and an inner rod, wherein the insert is carried within the outersheath, wherein the act of expanding the insert comprises providingrelative longitudinal movement between the outer sheath and the innerrod to thereby release the insert from the outer sheath, wherein the actof restricting the effective diameter of the ET is provided by theinsert resiliently returning to the expanded state.

IV. Miscellaneous

It should be understood that any of the examples described herein mayinclude various other features in addition to or in lieu of thosedescribed above. By way of example only, any of the examples describedherein may also include one or more of the various features disclosed inany of the various references that are incorporated by reference herein.

It should be understood that any one or more of the teachings,expressions, examples, examples, etc. described herein may be combinedwith any one or more of the other teachings, expressions, examples,examples, etc. that are described herein. The above-described teachings,expressions, examples, examples, etc. should therefore not be viewed inisolation relative to each other. Various suitable ways in which theteachings herein may be combined will be readily apparent to those ofordinary skill in the art in view of the teachings herein. Suchmodifications and variations are intended to be included within thescope of the claims.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions described above may be designed to be disposed of after asingle use, or they can be designed to be used multiple times. Versionsmay, in either or both cases, be reconditioned for reuse after at leastone use. Reconditioning may include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, someversions of the device may be disassembled, and any number of theparticular pieces or parts of the device may be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, some versions of the device may be reassembled forsubsequent use either at a reconditioning facility, or by a userimmediately prior to a procedure. Those skilled in the art willappreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various examples of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, examples, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

I/We claim:
 1. A system for providing a restriction in a patulousEustachian tube (ET) of a patient, the system comprising: (a) a guidecatheter comprising a shaft and a lumen extending therebetween, whereinthe guide catheter further comprises a distal end configured to provideaccess to an opening in the ET when the guide catheter is inserted intoa head of the patient; (b) an instrument comprising a shaft; and (c) aninsert comprising a body configured to radially expand and retractbetween a non-expanded state and an expanded state, wherein theinstrument is operable release the insert in the ET, wherein the insertis sized and shaped to be received within the lumen of the guidecatheter when in the non-expanded state, wherein the insert isconfigured to reduce an effective diameter of the ET after transitioningfrom the expanded state to the non-expanded state in the ET or aftertransitioning from the non-expanded state to the expanded state in theET.
 2. The system of claim 1, wherein the insert is resiliently biasedto the non-expanded state.
 3. The system of claim 2, wherein theinstrument further includes an expandable member, wherein the insert isconfigured to expand to the expanded state in response to a radiallyoutward force applied to the body by the expandable member.
 4. Thesystem of claim 3, wherein the insert is sized and configured to receivethe expandable member when the insert is in the non-expanded state. 5.The system of claim 3, wherein the insert is releasably secured to theexpandable member.
 6. The system of claim 1, wherein the body comprisesa plurality of longitudinal struts, wherein the struts are assembled ina looped arrangement such that each strut is adjacent to another strutthereby forming a mesh pattern.
 7. The system of claim 1, wherein theinsert further comprises a fastening mechanism configured to securelyattach the insert to the ET upon contact between the body and the ET. 8.The system of claim 7, wherein the fastening mechanism is positionedalong the body.
 9. The system of claim 7, wherein the fasteningmechanism comprises a tissue binding coating along an outer surface ofthe body.
 10. The system of claim 1, wherein the insert is formed of abiodegradable material such that the insert is configured to dissolveafter a predetermined duration within the ET.
 11. The system of claim 1,wherein the insert is formed of an elastic material operable to flexiblyexpand the body.
 12. The system of claim 1, wherein the insert isresiliently biased toward the expanded state, wherein the guide catheteris configured to constrain the insert in the non-expanded state.
 13. Thesystem of claim 12, wherein the body is configured to contractlongitudinally when radially expanded to the expanded state.
 14. Thesystem of claim 12, wherein the insert includes a plurality ofpassageways extending within the body, wherein passageways areconfigured to enable fluid communication through the body.
 15. Thesystem of claim 12, wherein the instrument further comprises a pusheroperable to drive the insert out of the guide catheter in response torelative longitudinal movement between the guide catheter and thepusher.
 16. An apparatus for providing a restriction in a patulousEustachian tube (ET) of a patient, the apparatus comprising: (a) a body,wherein the body is resiliently biased to radially expand from anelongated state to a widened state, wherein a longitudinal length of thebody is configured to shorten when in the widened state such that thelongitudinal length of the body is longer in the elongated staterelative to the widened state, wherein the body is sized and configuredto be inserted in an ET when the body is in the elongated state, whereinthe body is sized and configured to bear against a sidewall of the ETwhen the body is in the widened state; and (b) a plurality ofpassageways formed through the body; wherein the body in the elongatedstate is sized and configured to be received within an interior of ashaft; and wherein the body in the widened state is operable to providerestricted fluid communication through an ET through via thepassageways.
 17. The apparatus of claim 16, wherein the body is formedof a biodegradable material such that the body is configured to dissolveafter a predetermined duration within the ET.
 18. A method for providinga restriction in a patulous Eustachian tube (ET) of a patient using aninsert, wherein the insert comprises a body configured to be expandablefrom a contracted state to an expanded state, the method comprising: (a)directing the insert into an oro-nasal cavity of the patient while theinsert is in the contracted state; (b) advancing the insert into anopening of the ET; (c) further advancing the insert within the ET to adesired target site; (d) expanding the insert to the expanded state; and(e) restricting an effective diameter of the ET via the insert.
 19. Themethod of claim 18, wherein the insert is resiliently biased toward thecontracted state, wherein the acts of directing, advancing, and furtherexpanding are performed using an instrument having an expandable member,wherein the insert is carried by the expandable member, wherein the actof expanding the insert comprises expanding an expandable member toovercome the resilient bias of the insert, wherein the expanded insertis secured to the ET, wherein the act of restricting the effectivediameter of the ET comprises contracting the expandable member, therebyallowing the insert to resiliently return to the contracted state. 20.The method of claim 18, wherein the insert is resiliently biased towardthe expanded state, wherein the acts of directing, advancing, andfurther expanding are performed using an instrument having an outersheath and an inner rod, wherein the insert is carried within the outersheath, wherein the act of expanding the insert comprises providingrelative longitudinal movement between the outer sheath and the innerrod to thereby release the insert from the outer sheath, wherein the actof restricting the effective diameter of the ET is provided by theinsert resiliently returning to the expanded state.